Objective:To explore differences in the efficacy and safety of ruxolitinib in patients with myelofibrosis by age and to identify prognostic factors by analyzing clinical features and characteristics of chromosomes and gene mutations.Methods:This study retrospectively analyzed 188 patients with myelofibrosis who received ruxolitinib in the Department of Hematology, Qilu Hospital, Shandong University from January 1, 2017, to July 1, 2024. According to age at diagnosis, the patients were divided into the middle-aged group (≤55 years), young elderly group (56-65 years), and elderly group (>65 years). Clinical features, the characteristics of chromosomes and gene mutations, and the efficacy and safety of ruxolitinib treatment were compared across the three age groups. Independent factors influencing overall survival were identified through Cox proportional risk regression analysis.Results:Before treatment, the elderly group had more underlying comorbidities, a heavier symptom burden, higher leukocyte count, higher proportion and frequency of JAK2 mutations, and lower proportion of CALR mutations. The incidence of nondriver gene mutations was significantly higher in the young elderly group. After ruxolitinib treatment, the degree of reduction in spleen size did not differ significantly among the three groups. The length of the palpable spleen below the left costal margin reduced by more than 50% from baseline in 50.9% (27/53) of the patients in the middle-aged group, 43.5% (27/62) in the young elderly group, and 45.5% (20/44) in the elderly group ( P=0.720). No significant difference was observed among the three groups in the degree of reduction in Myeloproliferative Neoplasm Symptom Assessment Form (10-item version) score ( P=0.153), with a reduction in total symptom score by more than 50% achieved by 54.0% (27/50), 60.3% (41/68), and 66.7% (34/51) of the patients from the three groups, respectively ( P=0.429). The most common hematological adverse events were anemia and thrombocytopenia, while the most common nonhematological adverse events were electrolyte disturbance, elevated transaminase activity, and pulmonary infection. Multivariate analysis indicated that in ruxolitinib-treated patients with myelofibrosis, poor overall survival was independently predicted by increased age, reduced hemoglobin, percentage of bone marrow blasts ≥ 1%, absence of JAK2 mutations, chromosomal abnormalities, ≥2 high-molecular-risk mutations, and TP53 mutations. Conclusions:Patients with myelofibrosis stratified by age exhibited heterogeneous clinical features and gene mutation profiles but similar efficacy of ruxolitinib treatment and occurrence of adverse events.

Objective:To systematically evaluate the measurement properties of foot care behavior assessment tools for patients with diabetes mellitus and the methodological quality of the study, and to inform the selection of a high-quality assessment tool for healthcare professionals.Methods:Two researchers independently searched Chinese and English databases such as CINAHL, Web of Science, Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, VIP, and Wanfang Data to screen for studies of foot care behavior assessment tools for patients with diabetes mellitus. The search period was from database establishment to June 2024. Based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) systematic review guideline, the risk of bias checklist and quality standard rating scale were used to evaluate the measurement properties and form recommendations.Results:A total of 20 studies were included, comprising 9 diabetes foot care behavior assessment tools, of which 12 were translated versions of the original scales and the remaining 8 were developed and validated as localized scales in each country. None of the studies reported on the cross-cultural validity and responsiveness of the assessment tools.Conclusions:None of the foot care behavior assessment tools for patients with diabetes mellitus included in this study has perfect measurement properties. Compared with other scales, the Chinese Community Diabetic Foot Care Behavior Questionnaire and the Colombian Instrument of Self-Care for Prevention of Diabetic Foot (ISPDF) provide evidence of high-quality psychometric properties and can be recommended for use, but further in-depth validation is needed. There is no evidence of "adequate" content validity and internal consistency for the remaining scales, which are recommended at Level B.

Pulmonary artery thrombectomy is an important method for treatment of acute pulmonary embolism(PE),and its successful implementation relies on the close collaboration of a multidisciplinary team.This article explores the indications,surgical strategies and key links of multidisciplinary treatment(MDT)for pulmonary artery thrombectomy through the diagnosis and treatment process of a patient with acute pulmonary embolism.The patient sought medical attention due to wheezing and was diagnosed with pulmonary embolism through imaging,with a risk stratification of medium to high risk.With the collaboration of multiple disciplines including respiratory medicine department,cardiology department,cardiac surgery department,radiology department and ultrasound department,percutaneous mechanical thrombectomy was successfully performed.After the surgery,the patient's blood flow was restored,symptoms were significantly relieved,and no serious complications occurred.This article aims to provide a reference framework for MDT in pulmonary artery thrombectomy for clinical doctors,optimize the treatment process for patients with pulmonary embolism,and provide reference for case selection and diagnosis and treatment strategies of thrombectomy treatment of pulmonary embolism.

Pulmonary artery thrombectomy is an important method for treatment of acute pulmonary embolism(PE),and its successful implementation relies on the close collaboration of a multidisciplinary team.This article explores the indications,surgical strategies and key links of multidisciplinary treatment(MDT)for pulmonary artery thrombectomy through the diagnosis and treatment process of a patient with acute pulmonary embolism.The patient sought medical attention due to wheezing and was diagnosed with pulmonary embolism through imaging,with a risk stratification of medium to high risk.With the collaboration of multiple disciplines including respiratory medicine department,cardiology department,cardiac surgery department,radiology department and ultrasound department,percutaneous mechanical thrombectomy was successfully performed.After the surgery,the patient's blood flow was restored,symptoms were significantly relieved,and no serious complications occurred.This article aims to provide a reference framework for MDT in pulmonary artery thrombectomy for clinical doctors,optimize the treatment process for patients with pulmonary embolism,and provide reference for case selection and diagnosis and treatment strategies of thrombectomy treatment of pulmonary embolism.

Objective:To systematically evaluate the measurement properties of foot care behavior assessment tools for patients with diabetes mellitus and the methodological quality of the study, and to inform the selection of a high-quality assessment tool for healthcare professionals.Methods:Two researchers independently searched Chinese and English databases such as CINAHL, Web of Science, Cochrane Library, PubMed, Embase, China National Knowledge Infrastructure, VIP, and Wanfang Data to screen for studies of foot care behavior assessment tools for patients with diabetes mellitus. The search period was from database establishment to June 2024. Based on the Consensus-based Standards for the selection of health Measurement Instruments (COSMIN) systematic review guideline, the risk of bias checklist and quality standard rating scale were used to evaluate the measurement properties and form recommendations.Results:A total of 20 studies were included, comprising 9 diabetes foot care behavior assessment tools, of which 12 were translated versions of the original scales and the remaining 8 were developed and validated as localized scales in each country. None of the studies reported on the cross-cultural validity and responsiveness of the assessment tools.Conclusions:None of the foot care behavior assessment tools for patients with diabetes mellitus included in this study has perfect measurement properties. Compared with other scales, the Chinese Community Diabetic Foot Care Behavior Questionnaire and the Colombian Instrument of Self-Care for Prevention of Diabetic Foot (ISPDF) provide evidence of high-quality psychometric properties and can be recommended for use, but further in-depth validation is needed. There is no evidence of "adequate" content validity and internal consistency for the remaining scales, which are recommended at Level B.

Objective:To explore differences in the efficacy and safety of ruxolitinib in patients with myelofibrosis by age and to identify prognostic factors by analyzing clinical features and characteristics of chromosomes and gene mutations.Methods:This study retrospectively analyzed 188 patients with myelofibrosis who received ruxolitinib in the Department of Hematology, Qilu Hospital, Shandong University from January 1, 2017, to July 1, 2024. According to age at diagnosis, the patients were divided into the middle-aged group (≤55 years), young elderly group (56-65 years), and elderly group (>65 years). Clinical features, the characteristics of chromosomes and gene mutations, and the efficacy and safety of ruxolitinib treatment were compared across the three age groups. Independent factors influencing overall survival were identified through Cox proportional risk regression analysis.Results:Before treatment, the elderly group had more underlying comorbidities, a heavier symptom burden, higher leukocyte count, higher proportion and frequency of JAK2 mutations, and lower proportion of CALR mutations. The incidence of nondriver gene mutations was significantly higher in the young elderly group. After ruxolitinib treatment, the degree of reduction in spleen size did not differ significantly among the three groups. The length of the palpable spleen below the left costal margin reduced by more than 50% from baseline in 50.9% (27/53) of the patients in the middle-aged group, 43.5% (27/62) in the young elderly group, and 45.5% (20/44) in the elderly group ( P=0.720). No significant difference was observed among the three groups in the degree of reduction in Myeloproliferative Neoplasm Symptom Assessment Form (10-item version) score ( P=0.153), with a reduction in total symptom score by more than 50% achieved by 54.0% (27/50), 60.3% (41/68), and 66.7% (34/51) of the patients from the three groups, respectively ( P=0.429). The most common hematological adverse events were anemia and thrombocytopenia, while the most common nonhematological adverse events were electrolyte disturbance, elevated transaminase activity, and pulmonary infection. Multivariate analysis indicated that in ruxolitinib-treated patients with myelofibrosis, poor overall survival was independently predicted by increased age, reduced hemoglobin, percentage of bone marrow blasts ≥ 1%, absence of JAK2 mutations, chromosomal abnormalities, ≥2 high-molecular-risk mutations, and TP53 mutations. Conclusions:Patients with myelofibrosis stratified by age exhibited heterogeneous clinical features and gene mutation profiles but similar efficacy of ruxolitinib treatment and occurrence of adverse events.

Objective:To explore the value of cardiodynamicsgram (CDG) obtained from electrocardiogram (ECG) data by radial basis functionradial basis function (RBF) neural network in early diagnosis of patients with acute coronary syndrome (ACS).Methods:Retrospective analysis method was used. Patients with chest pain as the main initial symptom in the emergency department of Baoan District People's Hospital of Shenzhen from October 2021 to September 2022 were enrolled. Baseline data were collected, including gender, age, smoking history, family history of coronary heart disease and history of hypertension, diabetes, hyperlipidemia, and atherosclerosis. The first 12-lead ECG was recorded after admission to the emergency department, and electrocardiodynamics analysis was performed to generate CDG. Receiver operator characteristic curve (ROC curve) was plotted to analyze the value of CDG and ECG in the early diagnosis of ACS and non-ST segment elevation ACS (NSTE-ACS). Sensitivity, specificity, area under the ROC curve (AUC), and 95% confidence interval (95% CI) were calculated. CDG and coronary angiography results of 3 patients with ACS with normal ECG were observed and analyzed. Non-ACS patients with normal ECG but positive CDG were followed for 30 days for adverse cardiovascular events. Results:A total of 384 patients with chest pain were included, including 169 patients with ACS and 215 patients without ACS. The proportion of male (87.0% vs. 53.0%), smoking history (37.9% vs. 12.1%), hypertension (46.2% vs. 22.3%), diabetes (24.3% vs. 7.9%), hyperlipidemia (55.0% vs. 14.0%) and history of atherosclerosis (22.5% vs. 2.3%) in ACS group were significantly higher than those in non-ACS group (all P < 0.05). The ROC curve showed that the AUC of CDG diagnosis of ACS was higher than that of ECG [AUC (95% CI): 0.88 (0.66-0.76) vs. 0.71 (0.84-0.92)], the sensitivity was 92.8%, 78.6%, and the specificity was 83.3%, 64.2%, respectively. The AUC of CDG diagnosis of NSTE-ACS was higher than that of ECG [AUC (95% CI): 0.85 (0.80-0.90) vs. 0.63 (0.56-0.69)], the sensitivity was 87.1%, 61.3%, and the specificity was 83.3%, 64.2%, respectively. CDG of 3 patients with ACS with normal ECG showed disordered state, and coronary angiography showed ≥70% stenosis of major coronary branches. Of 215 non-ACS patients, 20 had a normal ECG but positive CDG, and 3 developed ST segment elevation myocardial infarction (STEMI) within 30 days, and 2 developed unstable angina (UA) within 30 days. Conclusion:CDG has high value in early diagnosis of ACS patients and is expected to become an important means of early diagnosis of ACS in emergency.

We aimed to evaluate the effectiveness and safety of single-course initial regimens in patients with low-risk gestational trophoblastic neoplasia (GTN). In this trial (NCT01823315), 276 patients were analyzed. Patients were allocated to three initiated regimens: single-course methotrexate (MTX), single-course MTX + dactinomycin (ACTD), and multi-course MTX (control arm). The primary endpoint was the complete remission (CR) rate by initial drug(s). The primary CR rate was 64.4% with multi-course MTX in the control arm. For the single-course MTX arm, the CR rate was 35.8% by one course; it increased to 59.3% after subsequent multi-course MTX, with non-inferiority to the control (difference -5.1%,95% confidence interval (CI) -19.4% to 9.2%, P = 0.014). After further treatment with multi-course ACTD, the CR rate (93.3%) was similar to that of the control (95.2%, P = 0.577). For the single-course MTX + ACTD arm, the CR rate was 46.7% by one course, which increased to 89.1% after subsequent multi-course, with non-inferiority (difference 24.7%, 95% CI 12.8%-36.6%, P < 0.001) to the control. It was similar to the CR rate by MTX and further ACTD in the control arm (89.1% vs. 95.2%, P =0.135). Four patients experienced recurrence, with no death, during the 2-year follow-up. We demonstrated that chemotherapy initiation with single-course MTX may be an alternative regimen for patients with low-risk GTN.
Antineoplastic Combined Chemotherapy Protocols/adverse effects* ; Dactinomycin/adverse effects* ; Female ; Gestational Trophoblastic Disease/drug therapy* ; Humans ; Methotrexate/therapeutic use* ; Pregnancy ; Retrospective Studies

Objective:To evaluate the clinical efficacy of hyperbaric oxygen as adjunctive therapy for neurological tinnitus (NT).Methods:Relevant clinical studies in eight databases (PubMed, Embase, Cochrane library, Web of Science, CBM, Cqvip, Wanfang data, and CNKI) were systematically searched, and data from the relevant studies were extracted based on inclusion and exclusion criteria. The methodological quality assessment of the data was conducted by using the Cochrane Collaboration’s tool for assessing risk of bias, the data analysis was conducted by using RevMan 5.3, and the sensitivity analysis of publication bias detection was conducted by using Stata 15.Results:A total of 12 randomized controlled trials (RCTs) were included. The results of meta-analysis showed that hyperbaric oxygen therapy had sound clinical efficacy in treating NT [ OR=4.10, 95% CI (2.81, 5.98), P<0.01]. It also reduced the scores of tinnitus severity index [ WMD=11.38, 95% CI (10.53, 12.23), P<0.01]. There was obvious asymmetry in the funnel diagram, and Egger’s test results ( t=2.96, P<0.05) indicated publication bias. Conclusion:Hyperbaric oxygen as adjunctive therapy for neurological tinnitus can effectively reduce tinnitus severity, which is superior to conventional treatment alone.

Objective:To evaluate the clinical efficacy of hyperbaric oxygen as adjunctive therapy for neurological tinnitus (NT).Methods:Relevant clinical studies in eight databases (PubMed, Embase, Cochrane library, Web of Science, CBM, Cqvip, Wanfang data, and CNKI) were systematically searched, and data from the relevant studies were extracted based on inclusion and exclusion criteria. The methodological quality assessment of the data was conducted by using the Cochrane Collaboration’s tool for assessing risk of bias, the data analysis was conducted by using RevMan 5.3, and the sensitivity analysis of publication bias detection was conducted by using Stata 15.Results:A total of 12 randomized controlled trials (RCTs) were included. The results of meta-analysis showed that hyperbaric oxygen therapy had sound clinical efficacy in treating NT [ OR=4.10, 95% CI (2.81, 5.98), P<0.01]. It also reduced the scores of tinnitus severity index [ WMD=11.38, 95% CI (10.53, 12.23), P<0.01]. There was obvious asymmetry in the funnel diagram, and Egger’s test results ( t=2.96, P<0.05) indicated publication bias. Conclusion:Hyperbaric oxygen as adjunctive therapy for neurological tinnitus can effectively reduce tinnitus severity, which is superior to conventional treatment alone.